In the monarticular or localized type, changes are usually confined to one or the larger joints, occurs mostly in men and after 50. The knee, shoulder, elbow or hip is generally affected, but the vertebra may be, the entire spinal column becoming rigid. Mo tion of affected joints often produces a creak ing or grating sound. The pathological ap pearances are similar to those of the general type of the disease, but joint-injuries are more often an exciting cause. The joint becomes stiff, sore and pairiful and there is absorption of the ends of the bones, dislocation and de formity.
Heberden's nodes or nedosities, described by him in 1805, are small exostoses hard knobsp), seldom larger than peas, which form on either side of the distal joints of fingers. They may be present in either type of the disease, at first are tender and swollen, but later on apparently cause little discomfort. Sometimes the bone-enlargement surrounds the joint.
Arthritis deformans in children, although not frequent, is more acute and is more influ enced by poor food, cold and damp, etc. There is fever, sometimes a chill. The swell ing, stiffness and tenderness seem to be more in the soft parts than in harder tissues. The fingers are flexed and overlapped, the feet are strongly extended and the joints are rigid.
The diagnosis of arthritis deformans must be made from subacute and chronic rheuma tism, gonorrhoeal rheumatism, gout, progres sive muscular atrophy, Charcot's disease, etc. Recovery is rare, but the disease is not di rectly dangerous to life.
Treatment will vary according to the type of cause. Chronic infective foci as from ton sils, teeth, old suppuratur foci of the tubes, endometrium, intestines, prostate, etc., etc., should all be cleared up, not by too radical a surgery, such as divest the human being from his teeth, his intestines or other of his essen tial properties, but a stimulating, healthful, tonic therapy, chiefly psycho-therapeutic with the accessory aids of travel, or by hydrotherapy, or specially indicated pharmacotherapy — iron or arsenic if anaemia be present, mercury for syphilis, etc. Local treatment is usually worth less but certain forms of baking, counter-irri tation to the joints and certain types of deep massage for the trophic vegetative nerve fibers are indicated. See ANTHRMS ; GOUT; RHEU MATISM. Consult Jelliffe and White, 'Dis eases of the Nervous System) (Chapters on the Vegetative Nervous System and Bony Syndromes).